Should Beta Blockers Still Be Routine After a Heart Attack?

Intro

For decades, if you had a heart attack, the answer was simple: you left the hospital with a beta blocker. No debate, no nuance. But two new trials — published the same day in the New England Journal of Medicine — suggest that blanket approach may finally be cracking.

Context

The REBOOT trial (Spain & Italy, 8,400 patients) found no real benefit from beta blockers in people whose hearts were still pumping well after an MI. Deaths, repeat heart attacks, heart failure admissions? All essentially the same with or without the drug. Even more provocative, a sub-analysis in women hinted at worse outcomes with beta blockers — though that finding needs caution.

Meanwhile, the BETAMI-DANBLOCK trial (Scandinavia, 5,000 patients) pointed in the opposite direction: beta blockers did cut the risk of a second non-fatal heart attack. But they didn’t budge overall survival, stroke, or heart failure.

Together, the studies paint a murky picture. And that’s exactly the point.

My Take

Beta blockers made sense in the 1980s. Back then, we didn’t have quick stents, potent statins, or dual antiplatelet therapy. Slowing the heart gave patients breathing room.

Fast forward: modern reperfusion medicine has transformed outcomes. In this context, the added value of beta blockers for patients with preserved heart function looks small — maybe vanishing.

That doesn’t mean beta blockers are obsolete. For patients with weakened hearts, arrhythmias, or high blood pressure, they still matter. But the reflex prescription for everyone? That era might be ending.

Implications

Patients shouldn’t stop suddenly. If you’re on a beta blocker, keep taking it until your cardiologist advises otherwise.
Doctors may shift toward selectivity. Use them when there’s a clear reason (reduced ejection fraction, arrhythmia, uncontrolled BP).
Guidelines are due for a rethink. Forty years of “standard of care” may need rewriting — not a small deal in cardiology.

FAQ

Q: Does this mean beta blockers are harmful?
A: Not necessarily. They may still protect some groups. The signal in women needs more study before changing practice.

Q: Should I stop mine today?
A: No — stopping suddenly can be dangerous. This is a conversation for your cardiologist.

Q: What’s next?
A: More trials, especially looking at subgroups (age, sex, heart function). Expect guidelines to shift in the coming years.

Closing

Sometimes medicine changes not with a bang but with a slow fade. Beta blockers after a heart attack may not vanish overnight, but the days of “everyone, always” look numbered.